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Ogawa M, Kuwajima K, Yamane T, Hasegawa H, Yagi N, Shiota T. Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation. J Am Heart Assoc 2024; 13:e033196. [PMID: 38609840 DOI: 10.1161/jaha.123.033196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population. METHODS AND RESULTS We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome. CONCLUSIONS Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
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Affiliation(s)
- Mana Ogawa
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Ken Kuwajima
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Takafumi Yamane
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Hiroko Hasegawa
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Nobuichiro Yagi
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Takahiro Shiota
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
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Kagawa S, Hasegawa H, Kuwajima K, Yamane T, Ogawa M, Patel D, Salseth T, Sekhon N, Skaf S, Chakravarty T, Makar M, Makkar RR, Shiota T. Long-Term Impact of Small Mitral Valve Orifice Area after Transcatheter Edge-to-Edge Mitral Valve Repair on Clinical Outcome: A Three-Dimensional Echocardiography Study. J Am Soc Echocardiogr 2024; 37:328-337. [PMID: 37972791 DOI: 10.1016/j.echo.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Iatrogenic mitral stenosis is a complication associated with transcatheter edge-to-edge mitral valve repair. Some reports revealed the impact of mean transmitral pressure gradient after procedure on long-term clinical outcomes. However, the association between prognosis and mitral valve orifice area (MVA) after the procedure has been poorly studied. This study aimed to investigate the association between postprocedural small MVA, derived from three-dimensional (3D) transesophageal echocardiography (TEE), and long-term clinical outcomes in 2 cohorts: the degenerative mitral regurgitation (MR) cohort and the functional MR cohort. METHODS This retrospective study assessed 279 consecutive patients with 3D TEE data during transcatheter edge-to-edge mitral valve repair between January 2010 and December 2016. Mitral valve orifice area after device implantation was measured by 3D planimetry. The patients with degenerative and functional MR were stratified separately into 2 groups according to postprocedural MVA: normal MVA (MVA > 1.5 cm2) group and small MVA (MVA ≤ 1.5 cm2) group. RESULTS Of the 279 patients, 142 (51%) had degenerative MR and 137 (49%) had functional MR. The number of degenerative MR patients with small MVA was 38, whereas 42 patients were in the functional MR cohort. Patients with small MVA had higher rate of all-cause mortality in the degenerative MR group (log-rank test: P = .01) but not in the functional MR group (log-rank test: P = .52). In multivariate analysis small MVA was independently associated with all-cause mortality but not postprocedural transmitral pressure gradient. Neither small MVA nor transmitral pressure gradient was associated with all-cause mortality in patients with functional MR. CONCLUSION Small MVA measured by 3D TEE after transcatheter mitral edge-to-edge repair was associated with poor prognosis in patients with degenerative MR.
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Affiliation(s)
- Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mana Ogawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tracy Salseth
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Navjot Sekhon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sabah Skaf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Yagi N, Ogawa M, Kuwajima K, Hasegawa H, Yamane T, Shiota T. Impact of stroke volume assessment by three-dimensional transesophageal echocardiography on the classification of low-gradient aortic stenosis. J Echocardiogr 2024:10.1007/s12574-023-00638-4. [PMID: 38300382 DOI: 10.1007/s12574-023-00638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Accurate assessment of flow status is crucial in low-gradient aortic stenosis (AS). However, the clinical implication of three-dimensional transesophageal echocardiography (3DTEE) on flow status evaluation remains unclear. This study aimed to investigate the assessment of flow status using 3D TEE in low-gradient AS patients. METHODS We retrospectively reviewed patients diagnosed with low-gradient AS and preserved ejection fraction at our institution between 2019 and 2022. Patients were categorized into low-flow/low-gradient (LF-LG) AS or normal-flow/low-gradient (NF-LG) AS based on two-dimensional transthoracic echocardiography (2DTTE). We compared the left ventricular outflow tract (LVOT) geometry between the two groups and reclassified them using stroke volume index (SVi) obtained by 3DTEE. RESULTS Among 173 patients (105 with LF-LG AS and 68 with NF-LG AS), 54 propensity-matched pairs of patients were analyzed. 3DTEE-derived ellipticity index of LVOT was significantly higher in LF-LG AS patients compared to NF-LG AS patients (p = 0.012). We assessed the discordance in flow status classification between SVi2DTTE and SVi3DTEE in both groups using a cutoff value of 35 ml/m2. The LF-LG AS group exhibited a significantly higher discordance rate compared to the NF-LG AS group, with rates of 50% and 2%, respectively. The optimal cutoff values of SVi3DTEE for identifying low flow status, based on 2DTTE-derived cutoff values, were determined to be 43 ml/m2. CONCLUSIONS LVOT ellipticity in low-gradient AS patients varies depending on flow status, and this difference contributes to discrepancies between SVi3DTEE and SVi2DTTE, particularly in LF-LG AS patients. Utilizing SVi3DTEE is valuable for accurately assessing flow status.
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Affiliation(s)
- Nobuichiro Yagi
- Cedars-Sinai Medical Center, Smidt Heart Institute, Beverly Blvd, Los Angeles, CA, 8700, USA.
| | - Mana Ogawa
- Cedars-Sinai Medical Center, Smidt Heart Institute, Beverly Blvd, Los Angeles, CA, 8700, USA
| | - Ken Kuwajima
- Cedars-Sinai Medical Center, Smidt Heart Institute, Beverly Blvd, Los Angeles, CA, 8700, USA
| | - Hiroko Hasegawa
- Cedars-Sinai Medical Center, Smidt Heart Institute, Beverly Blvd, Los Angeles, CA, 8700, USA
| | - Takafumi Yamane
- Cedars-Sinai Medical Center, Smidt Heart Institute, Beverly Blvd, Los Angeles, CA, 8700, USA
| | - Takahiro Shiota
- Cedars-Sinai Medical Center, Smidt Heart Institute, Beverly Blvd, Los Angeles, CA, 8700, USA
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Kuwajima K, Ogawa M, Ruiz I, Yamane T, Hasegawa H, Yagi N, Rader F, Siegel RJ, Shiota T. Comparison of prognostic value among echocardiographic surrogates of right ventricular-pulmonary arterial coupling: A three-dimensional echocardiographic study. Echocardiography 2024; 41:e15717. [PMID: 37990989 DOI: 10.1111/echo.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES Right ventricular (RV)-pulmonary arterial (PA) coupling is important in various cardiac diseases. Recently, several echocardiographic surrogates for RV-PA coupling have been proposed and reported to be useful in predicting outcomes. However, it remains unclear which surrogate is the most clinically relevant. This study aimed to comprehensively compare the prognostic value of different echocardiographic RV-PA coupling surrogates. METHODS We retrospectively reviewed 242 patients with various cardiac conditions who underwent comprehensive transthoracic echocardiography with three-dimensional RV data. In addition to conventional parameters including tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and PA systolic pressure (PASP), we analyzed RV free wall and global longitudinal strain (FWLS and GLS). We also obtained RV ejection fraction (RVEF), stroke volume (SV), and end-systolic volume (ESV) using three-dimensional RV analysis. RV-PA coupling surrogates were calculated as TAPSE/PASP, FAC/PASP, FWLS/PASP, GLS/PASP, RVEF/PASP, and SV/ESV. The study endpoint was a composite outcome of all-cause death or cardiovascular hospitalization within 1 year. RESULTS In multivariable analysis, all the RV-PA coupling surrogates were independent predictors of the outcome. Among the surrogates, the model with TAPSE/PASP showed the lowest prognostic value in model fit and discrimination ability, whereas the model with RVEF/PASP exhibited the highest prognostic value. The partial likelihood ratio test indicated that the model with RVEF/PASP was significantly better than the model with TAPSE/PASP (p < .024). CONCLUSION All the RV-PA coupling surrogates were independent predictors of the outcome. Notably, RVEF/PASP had the highest prognostic value among the surrogates.
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Affiliation(s)
- Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mana Ogawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Irving Ruiz
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nobuichiro Yagi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Hasegawa H, Kuwajima K, Kagawa S, Yamane T, Rader F, Siegel RJ, Shiota T. Impact of eccentric jet on outcomes in patients with atrial functional mitral regurgitation: An echocardiographic study. Int J Cardiol 2023; 391:131342. [PMID: 37678430 DOI: 10.1016/j.ijcard.2023.131342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Previous studies have reported the mechanisms underlying atrial functional mitral regurgitation (A-FMR). Recently, A-FMR subtypes based on mitral regurgitation (MR) mechanisms were proposed: "central jet" due to insufficient leaflet remodeling and "eccentric jet" due to atriogenic tethering. However, their prognostic value remains unclear. Therefore, this study investigated the impact of A-FMR subtypes on clinical outcomes. METHODS Outpatients with significant A-FMR between January 2013 and December 2016 were retrospectively reviewed. They were classified into two subtypes according to the MR jet's direction. All-cause mortality, heart failure hospitalization, and any mitral valve interventions were the primary composite endpoint. RESULTS Among 101 patients with significant A-FMR, 32% had eccentric jet. The primary endpoint was observed in 56 patients during the follow-up period (median 0.7 years, range 0.1-4.2 years). Kaplan-Meier curves demonstrated that the composite endpoint was higher among patients with eccentric jet than those with central jet (log-rank p < 0.001). Eccentric jet (hazard ratio [HR] 2.46, 95% confidence interval [CI] 1.28-4.73; p = 0.007), age (HR 1.06, 95% CI 1.02-1.11; p = 0.002), symptoms (HR 6.22, 95% CI 2.18-17.8; p < 0.001), severe MR (HR 3.97, 95% CI 1.92-8.18; p < 0.001), and significant tricuspid regurgitation (TR; HR 2.00, 95% CI 1.01-3.97; p = 0.047) were independent predictors of the composite endpoint. CONCLUSIONS Patients with eccentric jet had poorer outcomes than those with central jet. Eccentric jet, age, symptoms, severe MR, and significant TR were independently associated with poor outcomes.
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Affiliation(s)
- Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Kuwajima K, Kagawa S, Yamane T, Hasegawa H, Makar M, Chakravarty T, Makkar RR, Shiota T. Underestimation of Intraprocedural Tricuspid Valve Pressure Gradient by Echocardiography in Patients Undergoing Tricuspid Transcatheter Edge-to-Edge Repair. J Cardiothorac Vasc Anesth 2023; 37:2161-2163. [PMID: 37481396 DOI: 10.1053/j.jvca.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
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Ogawa M, Kuwajima K, Yamane T, Hasegawa H, Yagi N, Shiota T. Effect of right ventricular free wall longitudinal strain on all-cause death in patients with isolated severe tricuspid regurgitation and atrial fibrillation. Front Cardiovasc Med 2023; 10:1188005. [PMID: 37808882 PMCID: PMC10551442 DOI: 10.3389/fcvm.2023.1188005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Background With the aging population and advanced catheter-based therapy, isolated tricuspid regurgitation (TR) with atrial fibrillation (AF) has gained increased attention; however, data on the prognostic effect of isolated TR with AF are limited because of the small number of patients among those with severe TR. Recently, right ventricular (RV) longitudinal strain by two-dimensional speckle-tracking echocardiography has been reported as an excellent indicator of RV dysfunction in severe TR. However, the prognostic implications of RV longitudinal strain in isolated severe TR associated with AF remain unclear. Therefore, this study aimed to reveal the prognostic value of this index in this population. Methods We retrospectively studied patients with severe isolated TR associated with AF in the absence of other etiologies in the Cedars-Sinai Medical Center between April 2015 and March 2018. Baseline clinical and echocardiographic data were studied including RV systolic function evaluated by RV free wall longitudinal strain (FWLS) and conventional parameters. All-cause death was defined as the primary endpoint. Results In total, 53 patients (median age, 85 years; female, 60%) with a median follow-up of 433 (60-1567) days were included. Fourteen patients (26%) died, and 66% had right heart failure (RHF) symptoms. By multivariable analysis, reduced RVFWLS was independently associated with all-cause death. Patients with RVFWLS of ≤18% had higher risk of all-cause death adjusted for age (log-rank P = 0.030, adjusted hazard ratio 4.00, 95% confidence interval, 1.11-14.4; P = 0.034). When patients were stratified into four groups by RHF symptoms and RVFWLS, the group with symptomatic and reduced RVFWLS had the worst outcome. Conclusion Reduced RVFWLS was independently associated with all-cause death in patients with isolated severe TR and AF. Our subset classification showed the worst outcome from the combination of RHF symptoms and reduced RVFWLS.
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Affiliation(s)
| | | | | | | | | | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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Yamane T, Kuwajima K, Kagawa S, Hasegawa H, Rader F, Siegel RJ, Shiota T. Outcome of Patients With Both Moderate Aortic Stenosis and Moderate Mitral Stenosis. Struct Heart 2023; 7:100183. [PMID: 37745685 PMCID: PMC10512010 DOI: 10.1016/j.shj.2023.100183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 09/26/2023]
Abstract
Aims This study aimed to investigate the symptoms and prognosis of patients with both moderate aortic stenosis (AS) and mitral stenosis (MS). Methods and Results We studied 82 patients with moderate AS and MS diagnosed via transthoracic echocardiography. The patients had a mean age of 79 ± 13 years and 95% of patients had degenerative MS. Out of 82 patients, 34 (41%) had heart failure (HF) symptoms (New York Heart Association class ≥ Ⅱ) or a history of HF admission. Left ventricular ejection fraction, stroke volume index, atrial fibrillation, and right ventricular systolic pressure were independent determinants of HF symptoms. The median follow-up duration was 3.2 (interquartile range, 1.0-4.9) years and clinical events occurred in 48 (59%) patients, including death in 11 (13%) patients, aortic or mitral valve interventions in 22 (27%) patients, and HF hospitalization in 15 (18%) patients. The 5-year survival free of the combined endpoint of aortic or mitral valve interventions, HF hospitalization, or death was 19%. A multivariate predictor of clinical events was HF symptoms (hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.30-4.14; p = 0.0045). Kaplan-Meier survival at 5 years was 61% without intervention and HF symptoms were not associated with mortality. Conclusions Among patients with both moderate AS and MS, left ventricular ejection fraction, stroke volume index, atrial fibrillation, and right ventricular systolic pressure were strong determinants of HF symptoms. HF symptoms were independently predictive of clinical events.
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Affiliation(s)
- Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J. Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Yamane T, Kuwajima K, Hasegawa H, Ogawa M, Yagi N, Rader F, Siegel RJ, Shiota T. NATURAL HISTORY OF PATIENTS WITH BOTH MODERATE CALCIFIC AORTIC STENOSIS AND MITRAL STENOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Yagi N, Shiota T, Kuwajima K, Yamane T, Hasegawa H, Ogawa M. QUANTIFICATION OF AORTIC VALVE AREA IN PATIENTS WITH BICUSPID AORTIC VALVE USING THREE-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Hasegawa H, Kuwajima K, Yamane T, Ogawa M, Yagi N, Makar M, Skaf S, Rader F, Chakravarty T, Siegel RJ, Makkar RR, Shiota T. COMPARISON OF THE EFFECT OF TRANSCATHETER EDGE-TO-EDGE REPAIR ON THE MITRAL VALVE APPARATUS ACCORDING TO ATRIAL FUNCTIONAL MITRAL REGURGITATION SUBTYPES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kuwajima K, Kagawa S, Yamane T, Hasegawa H, Makar M, Makkar RR, Shiota T. Comparison of Residual Tricuspid Regurgitation Severity Assessed by Intraprocedural and Postprocedural Echocardiography in Patients Undergoing Transcatheter Tricuspid Valve Repair. J Cardiothorac Vasc Anesth 2022; 36:4555-4557. [PMID: 36180287 DOI: 10.1053/j.jvca.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA.
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Ohta R, Okayasu T, Katagiri N, Yamane T, Obata M, Sano C. Giant Cell Arteritis Mimicking Polymyalgia Rheumatica: A Challenging Diagnosis. Cureus 2022; 14:e27517. [PMID: 36060348 PMCID: PMC9427023 DOI: 10.7759/cureus.27517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 01/16/2023] Open
Abstract
Giant cell arteritis (GCA) is an autoimmune disease that causes inflammation of the middle and large arteries. Rural areas have many older patients with various symptoms, so large-vessel-type GCA should be managed effectively. Older patients tend to show vague symptoms that cannot be adequately diagnosed and observed. Here, we have encountered a case of a 91-year-old woman with a chief complaint of fatigue diagnosed with large-vessel type GCA in collaboration with a rural clinic. Effective collaboration between physicians in rural hospitals and clinics is necessary for diagnosing and treating large-vessel GCA. In rural areas, without adequate healthcare professionals, physicians should share their abilities and collaborate smoothly to mitigate delays in consultation and treatment. To effectively treat large vessel-type GCA, rural general physicians should be familiar with the clinical course of the disease and treatment for rural comprehensive care.
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Sawano M, Katsuki T, Kitai T, Tamita K, Obunai K, Ikegami Y, Yamane T, Ueda I, Endo A, Maekawa Y, Kawamura A, Fukuda K, Kohsaka S. Beta blockers versus calcium channel blockers for provocation of vasospastic angina after drug-eluting stent implantation: a multicentre prospective randomised trial. Open Heart 2020; 7:openhrt-2020-001406. [PMID: 33087441 PMCID: PMC7580072 DOI: 10.1136/openhrt-2020-001406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background Drug-eluting stent-induced vasospastic angina (DES-VSA) has emerged as a novel complication in the modern era of percutaneous coronary intervention (PCI). Although beta blockers (BBs) are generally recommended for coronary heart disease, they may promote incidence of DES-VSA. This study aimed to compare the effects of calcium channel blockers (CCBs) perceived to be protective against DES-VSA and BBs on subsequent coronary events after second-generation drug-eluting stent implantation. Methods In this multicentre prospective, randomised study, 52 patients with coronary artery disease who underwent PCI for a single-vessel lesion with everolimus-eluting stent placement were randomised into post-stenting BB (N=26) and CCB (N=26) groups and followed for 24 months to detect any major cardiovascular events (MACE). A positive result on acetylcholine provocation testing during diagnostic coronary angiography (CAG) at 9 months was the primary endpoint for equivalence. MACE included all-cause death, non-fatal myocardial infarction, unstable angina, cerebrovascular disease or coronary revascularisation for stable coronary artery disease after index PCI. Results At 9 months, 42 patients (80.8%) underwent diagnostic coronary angiography and acetylcholine provocation testing. Among them, seven patients in each group were diagnosed with definite vasospasm (intention-to-treat analysis 26.9% vs 26.9%, risk difference 0 (−0.241, 0.241)). Meanwhile, the secondary endpoint, 24-month MACE, was higher in the CCB group (19.2%) than in the BB group (3.8%) (p=0.01). In detail, coronary revascularisation for stable coronary artery disease was the predominant endpoint that contributed to the greater proportion of MACE in the CCB group (CCB (19.2%) vs BB (3.8%), p=0.03). Conclusions The incidence of acetylcholine-induced coronary artery spasms did not differ between patients receiving BBs or CCBs at 9 months after PCI. However, a higher incidence of 2-year MACE was observed in the CCB group, suggesting the importance of BB administration. Trial registration number This study was registered at the Japanese University Hospital Medical Information Network (UMIN) Clinical Trial Registry (The Prospective Randomized Trial for Optimizing Medical Therapy After Stenting: Calcium-Beta Trial; UMIN000008321, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009536).
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Affiliation(s)
- Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.,Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Toshiomi Katsuki
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koichi Tamita
- Department of Cardiology, Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Hyogo, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Ichikawa, Japan
| | - Yukinori Ikegami
- Department of Cardiology, National Hospital Organisation Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ayaka Endo
- Department of Cardiology, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare Faculty of Medicine Graduate School of Medicine, Narita, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Isono K, Takahashi E, Miyoshi I, Tsuneto M, Hikosaka-Kuniishi M, Yamane T, Yamazaki H. Simultaneous Fluorescent Identification of Odontoblasts and Ameloblasts. J Dent Res 2020; 100:532-541. [PMID: 33289448 DOI: 10.1177/0022034520974576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The tooth is mainly composed of dentin and enamel. Identification of dentin-producing odontoblasts and enamel-producing ameloblasts using reporter techniques is useful to study tooth development and regeneration with tissue engineering. Ameloblasts express Amelogenin, Ameloblastin, Enamelin, and Amelotin, whereas odontoblasts express Dentin sialophosphoprotein (Dspp) and Dentin matrix protein1 (Dmp1). Although there are several transgenic lines using promoter elements or bacterial artificial chromosomes (BACs) to label odontoblasts and ameloblasts, there is a possibility that the expression patterns vary from the endogenous genes. Here, we established 2 lines of mice where tdTomato was knocked into the second exon of X-chromosomal Amelogenin (Amelx), and green fluorescent protein (GFP) was knocked into the second exon of Dspp. tdTomato and GFP were highly expressed on secretory ameloblasts and secretory and fully differentiated odontoblasts, respectively. In addition, DSPP and AMELX were not produced in the dentin matrix and enamel matrix of DsppGFP/GFP and AmelxtdTomato male mice (as representative of AmelxtdTomato/Y hemizygous male mice), respectively. Moreover, micro-computed tomography analysis of AmelxtdTomato male mice revealed a notable reduction in enamel volume but increased dentin mineral density. DsppGFP/GFP mice had reduced dentin mineral density. To identify odontoblasts and ameloblasts from developing tooth, we examined the expression of mesenchymal cell surface molecules CD90, CD166 and epithelial cell surface molecules CD49f, Epcam1 with fluorescence on odontoblasts and ameloblasts in these mice. We found that GFP+ odontoblasts and tdTomato+ ameloblasts in tooth germ from 0.5-d-old DsppGFP/+ mice and AmelxtdTomato male mice were enriched in CD45-/Ter119-/Epcam1-/CD90+/Integrin α4+cell fractions and CD45-/Ter119-/Epcam1+/CD49f+/CD147+ cell fractions, respectively. By using antibodies against mesenchymal and epithelial cell surface molecules and fluorescence, we can easily distinguish odontoblasts from ameloblasts and isolate each cell for further studies. These mice would serve as useful models for tooth development and regeneration as well as provide concurrent observation for the differentiation processes of odontoblasts and ameloblasts in vivo and in vitro.
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Affiliation(s)
- K Isono
- Department of Stem Cells and Developmental Biology, Division of Fundamental Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - E Takahashi
- Support Unit for Animal Resources Development, Research Resources Division, RIKEN Center for Brain Science, Wako-shi, Saitama, Japan
| | - I Miyoshi
- Department of Laboratory Animal Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Tsuneto
- Division of Regenerative Medicine and Therapeutics, Department of Genetic Medicine and Regenerative Therapeutics, Tottori University Graduate School of Medical Science, Yonago, Tottori, Japan
| | - M Hikosaka-Kuniishi
- Department of Stem Cells and Developmental Biology, Division of Fundamental Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - T Yamane
- Department of Stem Cells and Developmental Biology, Division of Fundamental Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - H Yamazaki
- Department of Stem Cells and Developmental Biology, Division of Fundamental Medicine, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Miyoshi Y, Kitai T, Yamane T, Sano M, Koyama T, Furukawa Y. A huge cardiac haemangioma in the left ventricular wall. Eur Heart J Case Rep 2020; 4:1-2. [PMID: 33447701 PMCID: PMC7793202 DOI: 10.1093/ehjcr/ytaa374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Yutaro Miyoshi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan
| | - Madoka Sano
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
| | - Tadaaki Koyama
- Department of Cardiothoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe 6500047, Japan
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Yamane T, Hashiramoto A. AB0364 EFFICACY OF BARICITINIB (BARI) IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA) WHOSE RESPONSE WAS INADEQUATE TO TOFACITINIB (TOFA). Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Currently, four types of JAK inhibitors are approved for the treatment of RA in Japan, however, they often show differences in clinical efficacies presumably due to their JAK selectivity.Objectives:To investigate the efficacy of Bari for patients with Tofa-inadequate response (IR), clinical profiles of seven Tofa IR patients were evaluated.Methods:We performed a single-center retrospective study on seven Tofa IR patients (female:7) who were switched to Bari. Items evaluated were as follows; patient’s baseline characteristics, continuation rate of Bari, swollen joint count, tender joint count, C-reactive protein (CRP), matrix proteinase 3 (MMP3), physician’s and patient’s visual analog scale (VAS), disease activity assessed by Disease Assessment Score of 28 joints - C-reactive protein (DAS 28-CRP), simplified disease activity index (SDAI) and clinical disease activity index (CDAI) at 2, 4, 8, 12 weeks, and the dosage of prednisone (PSL).Results:Patient’s mean age was 56.4 and mean disease duration was 9.2 years. Tofa had administered for 3.4 months (range 1-10) before switching to Bari. All patients were positive for both anti-citrullinated protein antibodies and rheumatoid factor. The number of prior biologics use was 2.3 (range1-4). 3 patients had concomitant MTX use (mean dosage 5.3 mg/week) and 4 had prednisone (mean dosage 3.3 mg/day). Mean swollen joint counts and tender joint counts were 5.0 (range 1-15) and 5.3 (range 1-15), respectively. Physician’s and Patient’s VAS 0-100 were 71 mm (range 50-90) and 73 mm (range 50-80), mean CRP levels were 1.6 mg/dl (range 0.01-4.3) and MMP3 levels were 357.3 mg/dl (range 27-933). Mean SDAI, CDAI and DAS-28-CRP were 26.3 (range17-50), 24.7 (range17-47) and 4.5, respectively. When enrolled, 4 of 7 patients corresponded to moderate disease activity (MDA) and 3 were in high disease activity (HDA) by all composite measures. After switched to Bari, the patient’s VAS significantly decreased at week 2 (P <0.01). CDAI, SDAI and DAS28-CRP also showed a significant improvement at week 4, (P <0.05). At week 4, 2 patients discontinued Bari due to the lack of efficacy or acute exacerbation of interstitial pneumonia. Thus, continuation rate of Bari at week 12 was 71.4%. Among 5 patients who continues Bari, all patients achieved low disease activity (LDA) by SDAI and CDAI at week 12. By DAS 28-CRP, 2 patients achieved MDA, 2 achieved LDA and 1 achieved remission (mean 2.6), respectively, at week 12, 3 of 4 patients taking PSL were able to withdraw that before week 12 (Figure).Conclusion:Result showed the efficacy of Bari for patients with Tofa IR, representing inadequate improvements of patient’s VAS with Tofa. The efficacy of Bari can be expected from the early stage and continued up to 12 weeks after switching. This difference in therapeutic effect may be due to each mechanism of action, Bari inhibits JAK1/2, whereas Tofa mainly inhibits JAK1 /3 (1). JAK2 is important for signal by GM-CSF, which has shown potential as an important therapeutic target in RA (2).Inhibition of JAK2 and GM-CSF may be the reason for Bari efficacy in Tofa IR patients.References:[1]O’Shea JJ et al. Back to the future: oral targeted therapy for RA and other autoimmune diseases. Nat Rev Rheumatol 2013 Mar;9(3):173-82.[2]Wicks IP et al. Targeting GM-CSF in inflammatory diseases. Nat Rev Rheumatol. 2016 Jan;12(1):37-48.Disclosure of Interests:None declared
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Murakawa Y, Yamane T, Goya M, Inoue K, Naito S, Miyauchi Y, Morita N, Nogami A, Shoda M, Okumura K, Hirao K. P1865Incidence and predictors of invasively-treated pericardial effusion during catheter ablation of atrial fibrillation in Japan. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose and method
Japanese Heart Rhythm Society requested electrophysiology centers to register the data of patients who underwent catheter ablation for atrial fibrillation (AF) in designated eight months from 2011 to 2017. We assessed the incidence and predictors of pericardial effusion (PE) as an early complication of AF ablation.
Results
More than two hundred EP centers reported the data of 13,233 AF ablation cases (age; 64.2±10.7 years, male; 72.6%, paroxysmal AF; 63.4%). Clinically significant complications occurred in 601 subjects (4.5%). Critical PE occurred in 116 patients (0.8%), while six of them required open-chest surgery. Overall complication rate did not show significant changes. In contrast, incidence of PE declined over time (2012:1.2%, 2017:0.5%, p=0.003). Multiple logistic regression analysis showed that seven factors were related with higher incidence of PE. Among these factors, primary extra-PV ablation and hypertrophic cardiomyopathy (HCM) were more remarkably associated with higher rate of PE (PVI[−] vs. PVI[+]= 9.0% vs. 0.8%, OR 12.3, p<0.001; HCM: [+] vs. [−] = 2.6% vs. 0.8%, OR 3.26, p=0.001). Comorbidity of coronary artery disease (CAD) and use of CARTO system were related with lower PE rate (CAD: [+] vs [−] = 0.2% vs. 0.9%, OR 0.22 [p=0.034], CARTO: [+] vs [−] = 0.7% vs. 1.2%, OR 0.52 [p=0.001]). None of cryobaloon ablation, gender, type of AF, center volume, periprocedural oral anticoagulant, or left atrial diameter was significantly related with the occurrence of PE.
Conclusions
Incidence of critical PE decreased recently. HCM and primary extra-PV ablation were outstanding predictors of critical PE.
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Affiliation(s)
- Y Murakawa
- Teikyo University School of Medicine, Fourth Department of Internal Medicine, Kawasaki, Japan
| | - T Yamane
- Jikei University School of Medicine (Tokyo), Department of Cardiology, Tokyo, Japan
| | - M Goya
- Tokyo Medical and Dental University, Heart Rhythm Center, Tokyo, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Naito
- Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | | | - N Morita
- Tokai University Hachioji Hospital, Division of Cardiology, Hachioji, Japan
| | - A Nogami
- Tsukuba University, Cardiovascular Division, Tsukuba, Japan
| | - M Shoda
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Okumura
- Saiseikai Kumamoto Hospital, Division of Cardiology, Kumamoto, Japan
| | - K Hirao
- Tokyo Medical and Dental University, Heart Rhythm Center, Tokyo, Japan
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Kim K, Yamashita Y, Morimoto T, Kitai T, Yamane T, Ehara N, Kinoshita M, Kaji S, Amano H, Takase T, Hiramori S, Oi M, Akao M, Kobayashi Y, Toyofuku M, Izumi T, Tada T, Chen PM, Murata K, Tsuyuki Y, Saga S, Sasa T, Sakamoto J, Kinoshita M, Togi K, Mabuchi H, Takabayashi K, Shiomi H, Kato T, Makiyama T, Ono K, Furukawa Y, Kimura T. Risk Factors for Major Bleeding during Prolonged Anticoagulation Therapy in Patients with Venous Thromboembolism: From the COMMAND VTE Registry. Thromb Haemost 2019; 119:1498-1507. [PMID: 31230344 DOI: 10.1055/s-0039-1692425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are limited data assessing the risk for bleeding on anticoagulation therapy beyond the acute phase in patients with venous thromboembolism (VTE). The present study aimed to identify risk factors for major bleeding during prolonged anticoagulation therapy in VTE patients. PATIENTS AND METHODS The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTE. The current study population consisted of 2,728 patients who received anticoagulation therapy beyond the acute phase, after excluding those patients with major bleeding events (n = 48), death (n = 66), or loss to follow-up (n = 32) during the initial parenteral anticoagulation period within 10 days after diagnosis, and those without anticoagulation therapy beyond 10 days after diagnosis (n = 153). RESULTS During the median follow-up period of 555 days, major bleeding occurred in 189 patients (70 patients within 3 months; 119 patients beyond 3 months) with fatal bleeding in 24 patients (13%). The cumulative incidence of major bleeding was 2.7% at 3 months, 5.2% at 1 year, and 11.8% at 5 years. Active cancer (hazard ratio [HR], 3.06, 95% confidence interval [CI], 2.23-4.18), previous major bleeding (HR, 2.38, 95% CI, 1.51-3.59), anemia (HR, 1.75, 95% CI, 1.27-2.43), thrombocytopenia (HR, 2.11, 95% CI, 1.27-3.33), and age ≥75 years (HR, 1.64, 95% CI, 1.22-2.20) were independently associated with an increased risk for major bleeding by the multivariable Cox regression model. CONCLUSION Major bleeding events were not uncommon during prolonged anticoagulation therapy in real-world VTE patients. Active cancer, previous major bleeding, anemia, thrombocytopenia, and old age were the independent risk factors for major bleeding.
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Affiliation(s)
- Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Kinoshita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidewo Amano
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toru Takase
- Department of Cardiology, Kinki University Hospital, Osaka, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Maki Oi
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yohei Kobayashi
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Toshiaki Izumi
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomohisa Tada
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Po-Min Chen
- Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiaki Tsuyuki
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Syunsuke Saga
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Tomoki Sasa
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | | | - Kiyonori Togi
- Division of Cardiology, Nara Hospital, Faculty of Medicine, Kinki University, Ikoma, Japan
| | - Hiroshi Mabuchi
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | | | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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21
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Murakawa Y, Yamane T, Goya M, Inoue K, Naito S, Kumagai K, Miyauchi Y, Morita N, Nogami A, Shoda M, Hirao K. 359Do substrate modification in catheter ablation of atrial fibrillation increase the incidence acute complications: analysis of 10,795 procedures. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Y Murakawa
- Teikyo University School of Medicine, Fourth Department of Internal Medicine, Kawasaki, Japan
| | - T Yamane
- Jikei University School of Medicine (Tokyo), Tokyo, Japan
| | - M Goya
- Tokyo Medical and Dental University, Tokyo, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Naito
- Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - K Kumagai
- Fukuoka Sanno Hospital, Fukuoka, Japan
| | | | - N Morita
- Tokai University Hachioji Hospital, Hachioji, Japan
| | - A Nogami
- Tsukuba University, Tsukuba, Japan
| | - M Shoda
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Hirao
- Tokyo Medical and Dental University, Tokyo, Japan
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22
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Azumi Y, Tani T, Ishibashi K, Konda T, Sumida T, Sasaki Y, Ota M, Kim K, Kitai T, Yamane T, Kobori A, Ehara N, Kinoshita M, Kaji S, Furukawa Y. 1470Impact of left atrial enlargement on very long-term outcomes in patients with hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Azumi
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Tani
- Kobe City College of Nursing, kobe, Japan
| | - K Ishibashi
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Konda
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Sumida
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - Y Sasaki
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - M Ota
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - K Kim
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Yamane
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - A Kobori
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - N Ehara
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - M Kinoshita
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - S Kaji
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - Y Furukawa
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
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23
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Ota M, Kitai T, Horita R, Azumi Y, Matsumoto Y, Ishizu K, Sasaki Y, Kim K, Yamane T, Kobori A, Ehara N, Kinoshita M, Kaji S, Furukawa Y. P3418A detailed assessment of geometric height of normal aortic cusps by 3-dimensional transesophageal echocardiography: implications for aortic valve repair surgery. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Ota
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - R Horita
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - Y Azumi
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - Y Matsumoto
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - K Ishizu
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - Y Sasaki
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - K Kim
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - T Yamane
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - A Kobori
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - N Ehara
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - M Kinoshita
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - S Kaji
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
| | - Y Furukawa
- Kobe City Medical Center General Hospital, Cardiovascular Medicine, Kobe, Japan
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Nagai T, Honda Y, Nakano H, Honda S, Iwakami N, Mizuno A, Komiyama N, Yamane T, Furukawa Y, Miyagi T, Nishihara S, Tanaka N, Adachi T, Hamasaki T, Asaumi Y, Tahara Y, Aiba T, Sugano Y, Kanzaki H, Noguchi T, Kusano K, Yasuda S, Ogawa H, Anzai T. Rationale and Design of Low-dose Administration of Carperitide for Acute Heart Failure (LASCAR-AHF). Cardiovasc Drugs Ther 2018; 31:551-557. [PMID: 29098501 DOI: 10.1007/s10557-017-6760-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUNDS Despite current therapies, acute heart failure (AHF) remains a major public health burden with high rates of in-hospital and post-discharge morbidity and mortality. Carperitide is a recombinantly produced intravenous formulation of human atrial natriuretic peptide that promotes vasodilation with increased salt and water excretion, which leads to reduction of cardiac filling pressures. A previous open-label randomized controlled study showed that carperitide improved long-term cardiovascular mortality and heart failure (HF) hospitalization for patients with AHF, when adding to standard therapy. However, the study was underpowered to detect a difference in mortality because of the small sample size. METHODS Low-dose Administration of Carperitide for Acute Heart Failure (LASCAR-AHF) is a multicenter, randomized, open-label, controlled study designed to evaluate the efficacy of intravenous carperitide in hospitalized patients with AHF. Patients hospitalized for AHF will be randomly assigned to receive either intravenous carperitide (0.02 μg/kg/min) in addition to standard treatment or matching standard treatment for 72 h. The primary end point is death or rehospitalization for HF within 2 years. A total of 260 patients will be enrolled between 2013 and 2018. CONCLUSION The design of LASCAR-AHF will provide data of whether carperitide reduces the risk of mortality and rehospitalization for HF in selected patients with AHF.
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Affiliation(s)
- Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. .,National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK.
| | - Yasuyuki Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroki Nakano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naotsugu Iwakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadayoshi Miyagi
- Division of Cardiology, Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Syuzo Nishihara
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Taichi Adachi
- Department of Cardiovascular Medicine, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | - Toshimitsu Hamasaki
- Department of Data Science, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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25
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Kitai T, Tang WHW, Xanthopoulos A, Murai R, Yamane T, Kim K, Oishi S, Akiyama E, Suzuki S, Yamamoto M, Kida K, Okumura T, Kaji S, Furukawa Y, Matsue Y. Impact of early treatment with intravenous vasodilators and blood pressure reduction in acute heart failure. Open Heart 2018; 5:e000845. [PMID: 30018782 PMCID: PMC6045748 DOI: 10.1136/openhrt-2018-000845] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/25/2018] [Accepted: 06/13/2018] [Indexed: 01/19/2023] Open
Abstract
Objective Although vasodilators are used in acute heart failure (AHF) management, there have been no clear supportive evidence regarding their routine use. Recent European guidelines recommend systolic blood pressure (SBP) reduction in the range of 25% during the first few hours after diagnosis. This study aimed to examine clinical and prognostic significance of early treatment with intravenous vasodilators in relation to their subsequent SBP reduction in hospitalised AHF. Methods We performed post hoc analysis of 1670 consecutive patients enrolled in the Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure. Intravenous vasodilator use within 6 hours of hospital arrival and subsequent SBP changes were analysed. Outcomes were gauged by 1-year mortality and diuretic response (DR), defined as total urine output 6 hours posthospital arrival per 40 mg furosemide-equivalent diuretic use. Results Over half of the patients (56.0%) were treated with intravenous vasodilators within the first 6 hours. In this vasodilator-treated cohort, 554 (59.3%) experienced SBP reduction ≤25%, while 381 (40.7%) experienced SBP reduction >25%. In patients experiencing ≤25% drop in SBP, use of vasodilator was associated with greater DR compared with no vasodilators (p<0.001). Moreover, vasodilator treatment with ≤25% drop in SBP was independently associated with lower all-cause mortality compared with those treated without vasodilators (adjusted HR 0.74, 95% CI 0.57 to 0.96, p=0.028). Conclusions Intravenous vasodilator therapy was associated with greater DR and lower mortality, provided SBP reduction was less than 25%. Our results highlight the importance in early administration of intravenous vasodilators without causing excess SBP reduction in AHF management. Clinical trial registration URL: http://www.umin.ac.jp/ctr/ Unique identifier: UMIN000014105.
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Affiliation(s)
- Takeshi Kitai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cellular and Molecular Medicine, Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Clinical Genomics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andrew Xanthopoulos
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryosuke Murai
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Kida
- Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuya Matsue
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Cardiovascular Medicine, Juntendo University, Tokyo, Japan
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26
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Ishizu K, Kaji S, Sasaki Y, Ota M, Kim K, Kitai T, Yamane T, Ehara N, Kobori A, Kinoshita M, Furukawa Y. IMPACT OF LARGE FOCAL INTIMAL DISRUPTION ON DISEASE PROGRESSION IN PATIENTS WITH TYPE B AORTIC INTRAMURAL HEMATOMA. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32610-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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27
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Kim K, Kaji S, Kasamoto M, Murai R, Sasaki Y, Kitai T, Yamane T, Ehara N, Kobori A, Kinoshita M, Furukawa Y. Renin-angiotensin system inhibitors in patients with or without ischaemic mitral regurgitation after acute myocardial infarction. Open Heart 2017; 4:e000637. [PMID: 29259787 PMCID: PMC5729301 DOI: 10.1136/openhrt-2017-000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 10/07/2017] [Accepted: 11/07/2017] [Indexed: 01/14/2023] Open
Abstract
Objective Little is known about the long-term effects of renin–angiotensin system inhibitors (RASI) on cardiovascular events in patients after acute myocardial infarction (AMI) with ischaemic mitral regurgitation (IMR). The purpose of this study was to investigate the association of RASI with the incidence of adverse cardiac events in patients with or without IMR after AMI. Methods We reviewed charts of 1208 consecutive patients admitted with AMI who underwent emergency coronary angiography between 2000 and 2012. After excluding patients who died within 30 days, 551 patients were diagnosed to have mild or greater MR by transthoracic echocardiography (patients with IMR); the remaining 505 patients had no or trivial MR (non-IMR patients). Results Of the study patients, 395 (72%) patients with IMR and 403 (80%) non-IMR patients received RASI. Survival analysis showed that freedom from cardiac death and the composite of cardiac death and heart failure (HF) was significantly higher in patients with IMR receiving RASI than in those not receiving RASI (P<0.001 and P<0.001, respectively). Moreover, adjusted survival analysis using the inverse probability treatment weighting method showed a significant association of RASI therapy with reduced cardiac death (P=0.010) and the composite of cardiac death and HF (P=0.044) in patients with IMR. However, in non-IMR patients, there were no significant associations between RASI therapy and the outcome measures. Conclusions RASI therapy was associated with a lower incidence of adverse cardiac events in patients with IMR after AMI, but not in patients without IMR.
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Affiliation(s)
- Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Manabu Kasamoto
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Sasaki
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Kobori
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Kinoshita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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Okada A, Sugano Y, Nagai T, Honda Y, Iwakami N, Nakano H, Takashio S, Honda S, Asaumi Y, Aiba T, Noguchi T, Kusano K, Yasuda S, Anzai T, Kawakami S, Yamamoto Y, Yamamoto M, Motokawa T, Hamatani Y, Shibata T, Homma T, Chinen D, Yamane T, Yoshida C, Ogura S, Maruta A, Sumita Y. Usefulness of the Direct and/or Total Bilirubin to Predict Adverse Outcomes in Patients With Acute Decompensated Heart Failure. Am J Cardiol 2017; 119:2035-2041. [PMID: 28456315 DOI: 10.1016/j.amjcard.2017.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 12/20/2022]
Abstract
Abnormal liver function test results are often observed in acute decompensated heart failure (ADHF). However, the prognostic value of bilirubin fractionation has not been elucidated. The prognostic value of direct bilirubin (DB), in comparison with total bilirubin (TB), was examined in 556 consecutive patients with ADHF. Patients with elevated DB showed mostly similar patient characteristics including signs of elevated right-sided pressure (frequent hepatomegaly, jugular venous distention, dilated inferior vena cava, and elevated gamma-glutamyltransferase) and decreased cardiac output (cold extremities, decreased pulse pressure, and lower blood pressure) and other parameters of heart failure (HF) severity (increased plasma renin activity, decreased sodium, total cholesterol, and ejection fraction) to elevated TB; however, only patients with elevated DB showed a significant difference in the frequency of HF history and alkaline phosphatase value. Kaplan-Meier analysis showed that patients with elevated DB had a significantly higher rate of the composite end point of all-cause mortality or HF readmission (p = 0.021) compared with those with normal DB, whereas patients with elevated TB did not show a statistically significant difference compared with those with normal TB (NS). A multivariate Cox hazards model showed that DB was an independent predictor of adverse events (adjusted hazard ratio 1.052, 95% confidence interval 1.001 to 1.099, p = 0.034), whereas TB was not (adjusted hazard ratio 1.017, 95% confidence interval 0.985 to 1.046, p = 0.27). Adding DB to existing prognostic variables resulted in higher C-statistics than adding TB (C-statistics: 0.670 to 0.675, 0.670 to 0.674, respectively). In conclusion, elevated DB in ADHF was an independent prognostic predictor that was superior to TB. DB may be useful for further risk stratification in ADHF.
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Murakawa Y, Yamane T, Inoue K, Naito S, Kumagai K, Miyauchi Y, Morita N, Nogami A, Shoda M, Okumura K, Goya M, Hirao K. 1162Predictors of serious complications during and immediately after catheter ablation of atrial fibrillation in 8302 procedures: J-CARAF Study. Europace 2017. [DOI: 10.1093/ehjci/eux153.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Matsumoto Y, Kobori A, Sasaki Y, Murai R, Ota M, Kim K, Yamane T, Ehara N, Kinoshita M, Kaji S, Furukawa Y. P350Impact of the properties of ablation catheters on ATP-guided pulmonary vein isolation. Europace 2017. [DOI: 10.1093/ehjci/eux141.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ueda S, Saeki TS, Takeuchi H, Shigekawa T, Yamane T, Kuji I, Osaki A. Abstract P4-02-01: Eribulin induces vascular remodeling and reoxygenation in advanced breast cancer patients: A comparative study with bevacizumab. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Eribulin mesylate (eribulin) is a first-in-class halichondrin B-based microtubule dynamics inhibitor. To understand the mechanism of vascular remodeling of eribulin, we compared optical hemodynamic and blood biomarker changes between eribulin and bevacizumab.
Methods: Patients with advanced breast cancer with stage III/IV were eligible for the study. Patients were assigned to receive either eribulin or single-agent bevacizumab. Diffuse optical spectroscopic imaging (DOSI) measured tissue concentrations of oxy-hemoglobin (O2Hb), deoxy-hemoglobin (HHb), total hemoglobin (tHb) and oxygen saturation (SO2) of breast tumors before and day 7 after the first infusion. Peripheral blood samples were obtained from the patients to measure plasma concentration of VEGF, bFGF, FLT-3L, EGF, G-CSF, TNFα, IL1b, IL4, IL6, IL8, IL10, IL12p40, and TGF-β1.
Results: Baseline DOSI measurement of all 29 patients (eribulin, n = 14 and bevacizumab, n = 15) revealed significantly higher tumor concentrations of O2Hb, HHb, and tHb than that in the normal breast tissue. Eribulin significantly decreased in HHb concentration and increased SO2 during the observation period. This trend was not observed for bevacizumab. Instead, bevacizumab significantly decreased the concentration of O2Hb and tHb. The blood biomarker study revealed that both eribulin and bevacizumab decreased plasma concentrations of VEGF and bFGF, but only eribulin suppressed the plasma concentration of TGF-β1.
Conclusions:
Optical imaging technology revealed that eribulin, but not bevacizumab, induced tumor reoxygenation after the start of infusion. Eribulin had a potent anti-angiogenic properties as well as bevacizumab, while suppression of TGF-β1 observed by only eribulin could be associated with remodeling of the microvasculature through suppression of activated stromal cells.
Citation Format: Ueda S, Saeki TS, Takeuchi H, Shigekawa T, Yamane T, Kuji I, Osaki A. Eribulin induces vascular remodeling and reoxygenation in advanced breast cancer patients: A comparative study with bevacizumab [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-01.
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Affiliation(s)
- S Ueda
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
| | - TS Saeki
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
| | - H Takeuchi
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
| | - T Shigekawa
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
| | - T Yamane
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
| | - I Kuji
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
| | - A Osaki
- International Medical Center, Saitama Medical University, 1371-1 Yamane, Hidaka, Saitama, Japan
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Inoue M, Shiozawa K, Yoshihara R, Yamane T, Shima Y, Hirano T, Makimoto K. Predictors of poor sleep quality in patients with systemic lupus erythematosus. Clin Rheumatol 2017; 36:1053-1062. [PMID: 28138857 DOI: 10.1007/s10067-017-3545-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 11/26/2022]
Abstract
Sleep problems are common in patients with systemic lupus erythematosus (SLE). This study aimed to examine the following: (1) predictors of sleep quality and (2) fluctuations in sleep quality in patients with SLE. Patients with SLE were recruited from three rheumatology centers in Japan. We collected demographic and clinical data and data on sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI), the Medical Outcome Study Short Form-12, and the Lupus Patient Reported Outcome Tool (LupusPRO). Fluctuations in sleep quality were examined by administering the PSQI a second time after a 2-week interval. We used multiple linear regression analysis to predict sleep quality. Of 205 patients who completed the survey, 62.9% showed poor sleep quality. The largest fluctuation in sleep quality was for "waking in the middle of the night or early morning." "LupusPRO pain/vitality" was a major predictor of poor sleep. The other significant predictors were mostly LupusPRO subscales and clinical variables and SF-12 subscales were mostly non-predictive. The majority of the participants had poor sleep quality. A lupus-specific QoL scale is important for understanding poor sleep quality in SLE patients. Symptom management appeared to play a key role in improving sleep quality.
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Affiliation(s)
- M Inoue
- Department of Nursing, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Shiozawa
- Rheumatology & Collagen Disease Center, Hyogo Prefectural Kakogawa Medical Center, 203 Kanno, Kanno-cho, Kakogawa, Hyogo, 675-0003, Japan
| | - R Yoshihara
- Rheumatology & Collagen Disease Center, Hyogo Prefectural Kakogawa Medical Center, 203 Kanno, Kanno-cho, Kakogawa, Hyogo, 675-0003, Japan
| | - T Yamane
- Rheumatology Center, Kakogawa City Hospital, 439 Honmachi, Kakogawa-cho, Kakogawa, Hyogo, 675-0037, Japan
| | - Y Shima
- Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - T Hirano
- Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - K Makimoto
- Department of Nursing, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Inoue M, Shiozawa K, Yoshihara R, Yamane T, Shima Y, Hirano T, Jolly M, Makimoto K. The Japanese LupusPRO: A cross-cultural validation of an outcome measure for lupus. Lupus 2016; 26:849-856. [PMID: 27927882 DOI: 10.1177/0961203316682100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective This study aimed to validate the Japanese version of the LupusPRO questionnaire for use with systemic lupus erythematosus patients. Methods Participants were 205 lupus patients recruited from three rheumatology centers in Japan. Demographic data were collected and quality of life was assessed using the LupusPRO and the Short Form Health Survey-12. Disease activity was evaluated by physicians using the Systemic Lupus Erythematosus Activity Index. Some participants completed questionnaires 10-14 days after the first survey. Internal consistency reliability, test-retest reliability, content validity and convergent validity were examined, and confirmatory factor analysis was performed. Results Participants' mean age was 47.8 ± 13.6 years. Older participants scored lower on physical quality of life and higher on coping than younger participants. The LupusPRO showed satisfactory test-retest reliability ( n = 111). Test-retest reliability was lower for the mental and social aspects of quality of life, indicating fluctuations in quality of life during the two-week interval. Internal consistency reliability was good and convergent validity with the corresponding domains of the Short Form Health Survey-12 was satisfactory. Confirmatory factor analysis showed a good model fit. Conclusion The Japanese LupusPRO is a reliable and valid measure to evaluate treatment interventions for systemic lupus erythematosus.
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Affiliation(s)
- M Inoue
- 1 Department of Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - K Shiozawa
- 2 Rheumatology & Collagen Disease Center, Hyogo Prefectural Kakogawa Medical Center, Hyogo, Japan
| | - R Yoshihara
- 2 Rheumatology & Collagen Disease Center, Hyogo Prefectural Kakogawa Medical Center, Hyogo, Japan
| | - T Yamane
- 3 Rheumatology Center, Kakogawa City Hospital, Hyogo, Japan
| | - Y Shima
- 4 Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Hirano
- 4 Department of Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - M Jolly
- 5 Department of Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - K Makimoto
- 1 Department of Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
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Kikuchi H, Tanaka S, Nakagiri Y, Yamane T, Fujiwara S, Katsuhisa K, Tan A, Matsuo O. Hypofibrinolytic Activity after Total Joint Replacement. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449202600110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tissue-type plasminogen activator (t-PA), tissue-type plasminogen activator inhibitor (t-PAI), and other factors (platelets, fibrinogen, fibrinogen degrada tion products, antithrombin-III, plasminogen, and α2-plasmin inhibitor [α2-PI]) related to the fibrinolytic system were studied in 21 patients undergoing total joint replacement. Seventeen of the 21 patients revealed an impaired fibrinolytic activity from the first to seventh postoperative day and a subsequent return to the preopera tive level by the fourteenth postoperative day. There were accompanying increases in the level of α2-PI and in the t-PAI/t-PA ratio, and there was decrease in plas minogen level. Such hypofibrinolytic states may be related to a higher incidence of postoperative thrombosis in total joint replacement patients.
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Affiliation(s)
- H. Kikuchi
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - S. Tanaka
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - Y. Nakagiri
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - T. Yamane
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - S. Fujiwara
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - K. Katsuhisa
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - A. Tan
- Department of Orthopaedic Surgery, Kinki University School of Medicine
| | - O. Matsuo
- Department of Physiology, Kinki University School of Medicine, Osakasayama, Japan
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Nishikawa K, Fujitani K, Inagaki H, Akamaru Y, Tokunaga S, Takagi M, Tamura S, Sugimoto N, Shigematsu T, Yoshikawa T, Ishiguro T, Nakamura M, Yamane T, Yamada M, Imano M, Iijima S, Nashimoto A, Morita S, Miyashita Y, Tsuburaya A, Sakamoto J, Tsujinaka T. PD-035 Efficacy and safety of second-line irinotecan based chemotherapy in early relapse patients with gastric cancer after adjuvant chemotherapy: exploratory subgroup analysis of TRICS trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw200.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Werner RA, Maya Y, Yamane T, Rischpler C, Fukushima K, Chen X, Lapa C, Herrmann K, Higuchi T, Thorn S, Stacy M, Purcell B, Doviak H, Shuman J, Perez E, Burdick J, Spinale F, Sinusas A, Treibel T, Bandula S, Fontana M, White S, Gilbertson J, Punwani S, Gillmore J, Hawkins P, Taylor S, Moon J, Caobelli F, Wollenweber T, Kuehn C, Bavendiek U, Schuetze C, Geworski L, Bauersachs J, Haverich A, Bengel F, Barysheva N, Merkulova I, Shabanova M, Gaman S, Veselova T, Shariya M, Kelion AD, Pakkal M, Chowdhury F, Nagaraj N, Birchall J, Dixon K, Banya W, Mccann G, Gershlick A, Rischpler C, Dirschinger R, Nicolosi S, Kossmann H, Meinicke A, Hanus F, Goetze K, Laugwitz K, Schwaiger M, Nekolla S, Rischpler C, Dirschinger R, Nicolosi S, Kossmann H, Meinicke A, Hanus F, Goetze K, Laugwitz K, Schwaiger M, Nekolla S. Moderated Poster Session 4: Monday 4 May 2015, 15:30-16:30 * Room: Moderated Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kitai T, Okada Y, Yamane T, Kim K, Kaji S, Tani T, Furukawa Y. TRICUSPID ANNULOPLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION IN PATIENTS UNDERGOING MITRAL VALVE REPAIR FOR SEVERE MITRAL REGURGITATION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kitai T, Kaji S, Yamane T, Kim K, Tani T, Furukawa Y. PREVALENCE AND PROGNOSTIC VALUE OF ASYMPTOMATIC AORTIC ULCER: A MULTIDETECTOR COMPUTED TOMOGRAPHY STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62088-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tani T, Kitai T, Kim K, Yamane T, Kobori A, Ehara N, Kinoshita M, Kaji S, Furukawa Y. LEFT ATRIAL DYSFUNCTION IN PATIENTS WITH PRESSURE GRADIENT-AORTIC VALVE AREA MISMATCHED SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fujino M, Ishihara M, Honda S, Kawakami S, Yamane T, Nagai T, Nakao K, Kanaya T, Kumasaka L, Asaumi Y, Arakawa T, Tahara Y, Nakanishi M, Noguchi T, Kusano K, Anzai T, Goto Y, Yasuda S, Ogawa H. Impact of acute and chronic hyperglycemia on in-hospital outcomes of patients with acute myocardial infarction. Am J Cardiol 2014; 114:1789-93. [PMID: 25438903 DOI: 10.1016/j.amjcard.2014.09.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 01/08/2023]
Abstract
This study was undertaken to assess the impact of acute hyperglycemia (acute-HG) and chronic hyperglycemia (chronic-HG) on short-term outcomes in patients with acute myocardial infarction (AMI). This study consisted of 696 patients with AMI. Acute-HG was defined as admission plasma glucose ≥200 mg/dl and chronic-HG as hemoglobin A1c ≥6.5%. Acute-HG was associated with higher peak serum creatine kinase (4,094 ± 4,594 vs 2,526 ± 2,227 IU/L, p <0.001) and in-hospital mortality (9.8% vs 1.6%, p <0.001). On the contrary, there was no significant difference in peak creatine kinase (2,803 ± 2,661 vs 2,940 ± 3,181 IU/L, p = 0.59) and mortality (3.3 vs 3.7%, p = 0.79) between patients with chronic-HG and those without. Multivariate analysis showed that admission plasma glucose was an independent predictor of in-hospital mortality (odds ratio 1.15, 95% confidence interval 1.05 to 1.27, p <0.001), but hemoglobin A1c was not. When only patients with acute-HG were analyzed, chronic-HG was associated with a significantly smaller infarct size (3,221 ± 3,001 vs 5,904 ± 6,473 IU/L, p <0.001) and lower in-hospital mortality (5.5 vs 18.9%, p = 0.01). In conclusion, these results suggested that acute-HG, but not chronic-HG, was associated with adverse short-term outcomes after AMI. Paradoxically, in patients with acute-HG, chronic-HG might abate the adverse effects of acute-HG.
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Asaumi Y, Noguchi T, Morita Y, Fujiwara R, Kanaya T, Matsuyama TA, Kawasaki T, Fujino M, Yamane T, Nagai T, Miyagi T, Ishibashi-Ueda H, Higashi M, Komori Y, Ishihara M, Ogawa H, Yasuda S. High-Intensity Plaques on Noncontrast T1-Weighted Imaging as a Predictor of Periprocedural Myocardial Injury. JACC Cardiovasc Imaging 2014; 8:741-3. [PMID: 25457759 DOI: 10.1016/j.jcmg.2014.07.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/26/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
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Honda S, Asaumi Y, Yamane T, Nagai T, Miyagi T, Noguchi T, Anzai T, Goto Y, Ishihara M, Nishimura K, Ogawa H, Ishibashi-Ueda H, Yasuda S. Trends in the clinical and pathological characteristics of cardiac rupture in patients with acute myocardial infarction over 35 years. J Am Heart Assoc 2014; 3:e000984. [PMID: 25332178 PMCID: PMC4323797 DOI: 10.1161/jaha.114.000984] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years. Methods and Results The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977–1989, 1990–2000, and 2001–2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977–1989, 3.3%; 1990–2000, 2.8%; 2001–2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977–1989, 90%; 1990–2000, 56%; 2001–2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001). Conclusions With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion‐induced myocardial hemorrhage is emerging in the current PPCI era.
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Affiliation(s)
- Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.)
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Takafumi Yamane
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Tadayoshi Miyagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Yoichi Goto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Masaharu Ishihara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (K.N.)
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan (H.O.)
| | - Hatsue Ishibashi-Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.)
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Hospital, Suita, Japan (S.H., Y.A., T.Y., T.N., T.M., T.N., T.A., Y.G., M.I., H.O., H.I.U., S.Y.) Department of Advanced Cardiovascular Medicine, Kumamoto University, Kumamoto, Japan (S.H., S.Y.)
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Honda S, Asaumi Y, Yamane T, Kawakami S, Nagai T, Noguchi T, Ishihara M, Ueda H, Ogawa H, Yasuda S. Long Term Trends in the Clinical and Pathological Characteristics of Cardiac Rupture in Patients with Acute Myocardial Infarction. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kitajima R, Fujino M, Yamane T, Noguchi T, Kusano K, Anzai T, Goto Y, Ishihara M, Yasuda S, Ogawa H. A Case of Syncope and Cardiac Tamponade After Silent Acute Myocardial Infarction Successfully Diagnosed by Multiple Imaging Modalities. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.07.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Honda S, Yasuda S, Kawakami S, Yamane T, Nagai T, Asaumi Y, Noguchi T, Ishihara M, Ogawa H. Long Term Trend of Decreased Incidence and Mortality of Right Ventricular Infarction in Association with Increased Use of Reperfusion Therapy. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.07.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shiozawa K, Yamane T, Murata M, Tanaka C, Yo N, Yoshihara R, Tanaka Y, Tsumiyama K, Shiozawa S. FRI0006 Mmp3 Predicts A Subgroup of Rheumatoid Patients with Structural Remission under Low-Dose Methotrexate (MTX) Monotherapy. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shiozawa K, Yamane T, Murata M, Tanaka C, Yo N, Yoshihara R, Tanaka Y, Tsumiyama K, Shiozawa S. AB0394 Long Term Efficacy of Rheumatoid Arthritis (RA) Patients with Adequate Responses to Methotrexate (MTX) on Maintenance of Function and Structure: 3-Year Study Results. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Imai M, Kimura T, Morimoto T, Saito N, Shiomi H, Kawaguchi R, Kan H, Mukawa H, Fujita H, Ishise T, Hayashi F, Nagao K, Take S, Taniguchi H, Sakamoto H, Yamane T, Shirota K, Tamekiyo H, Okamura T, Kishi K, Miyazaki S, Yamamoto S, Yamaji K, Kawasaki T, Taguchi E, Nakajima H, Kosedo I, Tada T, Kadota K, Mitsudo K. Impact of angiographic peri-stent contrast staining (PSS) on late adverse events after sirolimus-eluting stent implantation: an observation from the multicenter j-Cypher registry PSS substudy. Cardiovasc Interv Ther 2014; 29:226-36. [PMID: 24532230 DOI: 10.1007/s12928-014-0248-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/25/2014] [Indexed: 11/30/2022]
Abstract
This study sought to assess clinical significance of angiographic peri-stent contrast staining (PSS) after sirolimus-eluting stent (SES) implantation in a large multicenter study with 5-year follow-up. The j-Cypher PSS substudy is a multicenter study including 5712 patients (7838 lesions) who underwent follow-up angiographic study within 12 months after SES implantation. Late acquired PSS was observed in 184 patients (3.2 %) or 194 lesions (2.5 %). Independent risk factors of PSS were chronic total occlusion and left anterior descending artery lesion, while negative risk factors were in-stent restenosis, diabetes mellitus, ≥70 years of age, and left circumflex coronary artery lesion. Cumulative incidence of definite very late stent thrombosis (VLST) at 4 years after the index follow-up angiography in lesions with PSS was significantly higher than that in lesions without PSS (5.3 versus 0.7 %, P < 0.0001). Late target-lesion revascularization (TLR) was also more frequently observed in the PSS group (13 versus 6.9 %, P = 0.01), while late TLR for restenosis excluding those TLR procedures for VLST tended to be higher in the PSS group (9.9 versus 6.3 %; P = 0.15). PSS found in 2.5 % of lesions within 12 months after SES implantation was associated with higher risk for subsequent VLST.
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Affiliation(s)
- Masao Imai
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shougoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Nakajima S, Seguchi O, Murata Y, Fujita T, Hata H, Yamane T, Hieda M, Watanabe T, Sato T, Sunami H, Yanase M, Kobayashi J, Nakatani T. Left coronary artery occlusion caused by a large thrombus on the left coronary cusp in a patient with a continuous-flow ventricular assist device. J Artif Organs 2014; 17:197-201. [PMID: 24509915 DOI: 10.1007/s10047-014-0758-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
Despite continual improvements in ventricular assist device (VAD) therapy, various clinical issues are emerging. Importantly, various types of thromboembolic complications have been reported to date. Recently, we encountered a rare continuous-flow VAD-related thromboembolic event that resulted in acute myocardial infarction. A 26-year-old female who just underwent HeartMate II(®) VAD implantation suddenly developed widespread anterolateral myocardial infarction on postoperative day 16. Echocardiography and aortography revealed a large thrombus on the left coronary cusp of the aortic valve that almost completely occluded the left coronary ostium. After VAD implantation, her aortic valve did not open, even at relatively low pump speeds; this was thought to be one of the causes for thrombus formation. Continuous suction of blood from the left ventricle and non-pulsatile flow into the ascending aorta resulted in a continuously closed aortic valve and stagnation of blood in the coronary cusp. Furthermore, both small body size (body surface area <1.3 m(2)) and postoperative right ventricular failure may have exacerbated blood stagnation and thrombus formation in this patient. We should have adjusted the anticoagulation and antiplatelet therapy protocols based on the patient's condition. She underwent off-pump coronary artery bypass surgery and remained in clinically stable condition afterwards.
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Affiliation(s)
- Seiko Nakajima
- Department of Transplantation, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
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Shiozawa K, Tanaka Y, Yoshihara R, Murata M, Yamane T, Tanaka C, You N, Shiozawa S. AB0176 Mmp-3 as a predictor that identifies a subgroup with potential radiographic progression requiring additional biologics to halt future progression among the rheumatoid arthritis patients succeedingly treated with methotrexate (mtx) alone. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.2499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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